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Help wiith diagnosis: 8 yo male asymptomatic unilateral forefoot plantar anhydrotic skin.

Discussion in 'Pediatrics' started by macci13, Jan 24, 2011.

  1. macci13

    macci13 Member


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    Hi all!

    I saw this patient in clinic.

    8 year old british asian male child.
    presents with thickened anhydrotic skin on the plantar aspect of his right forefoot only. The left was unremarkable.
    small superficial fissure around the base of the hallux (doesnt break down no pain)
    No lesions, not scaly, slightly flaky, no redness, no swelling, no clinical signs of tinia pedis.
    No family history of skin conditions.
    No eczema apparent on elbows, knees or ankles.
    patient not on any medication.
    no medical history. Is healthy, normal BMI.
    Shoes good leather, changes socks regularly.
    plays football daily at school.
    Functional/Biomechanical assessment shows no abnormalities. Pronated/ medially deviated STJ in both feet due to patients age and hypermobility, no pain elsewhere.

    G.P has been treating this patient for 2 years with no improvement. prescribed E45 and aqueous cream referred to podiatry.

    I have some differential diagnosis of Juvenile atopic eczema, eczema, atopical dermatitis.

    I have managed this patient as follows:

    1. CCS cream urea penetrates the deeper layers of the skin rather than E45 review in 4 weeks.
    2. At the review if no improvement hydrocortisone 1% cream OTC or prescribed.
    3. If still no improvement, refer to dermatologist.

    I would be greatful if someone could shed some light on the possible diagnosis for this patient?????

    Is this 3 phased management plan appropriate?????

    Any advice would be appreciated,

    Thanks.
     
  2. blinda

    blinda MVP

    Hi macci13,

    Difficult to comment on without a picture. However, from your description, it could be a case of juvenile plantar dermatosis (dermatitis). Sometimes called `glazed foot`, usually seen in young children and normally resolves by puberty.

    Clinically, it occurs as an erythematous dermatitis with increased plantar skin creases and fissuring, affecting primarily the forefoot and volar areas. This condition is often described as being much worse during the winter months with some improvement, or clearing, during the warmer summer months. It has been suggested that there may be a relationship between frictional dermatitis caused by shoes. So may be worth looking at a device to reduce friction.

    http://www.japmaonline.org/cgi/content/citation/82/3/167

    Treatment includes the wearing of properly fitting shoes and cotton socks. Application of an emollient cream after warm water soak is paramount as this will keep the skin supple. You are absolutely right to suggest the use of CCS (or any other urea based) cream. E45 is NOT an emollient. It is a soap substitute and as such, should only be used as a `wash on/wash off` cleanser. A mild corticosteroid cream can be used for acute episodes.

    Hope that helps!

    Cheers,
    Bel
     
  3. macci13

    macci13 Member

    Thankyou for the reply!

    That is a great help, I will control the friction at the review. The foot was similar to that of the file uploaded which is juvenile plantar dermatosis for those interested in this case study.

    Thanks again!
     

    Attached Files:

    • Doc1.doc
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  4. mimmypod

    mimmypod Member

    I've seen this condition in many adults too. Very hard to treat. Have not tried orthotics to decrease any possible friction though. I assume a multiform type top cover would help to reduce friction.

    Mimmy
     
  5. Kenva

    Kenva Active Member

    "Fleecy web" could do the trick in lowering the friction parameter.
    This would be in case you wouldn't feel like making a FO.
     
  6. footdrcb

    footdrcb Active Member

    This may be a shot in the dark , but in the absence of any injury or external issue, I saw a patient who had the same condition ,aged 40 some years ago. It was diagnosed by his GP as unitlateral piriformis syndrome that interupted the conduction to the peripheral nerve suppy . After a surgical release, his anhydrotic foot resolved.....

    Hope this helps ....as I said ...maybe just a shot in the dark

    FDCB
     
  7. davidh

    davidh Podiatry Arena Veteran

    I've never seen a case of unilateral JPD, although I've seen plenty of bi-lateral JPD.
    In each case the condition resolved with a change of washing powder and hand-rinsed (after each machine-wash) socks.

    I suggest this one may be activity-related, but that's only my shot in the dark.
     
  8. macci13

    macci13 Member

    thankyou for showing an interest in this case study.

    I reviewed this patient on the 5 weeks mark and the CCS cream has done the trick alone. I wish I had pictures to prove but there is a huge improvement and both patient and parents are very happy with the outcome of something which has been ongoing for about 2-3 year!!!
     
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